INFANTILE MORTALITY AND THE RELATIVE VALUE OF MEASURES FOR ITS PREVENTION

1916 BMJ (Clinical Research Edition)  
College of Ph-iysicians of London was Infantile mortality and the relative pr-actical valtue of measures directed to its prevention." I Tlle, course was delivered by Dr. S. G. MOORE, who, as nmedical officer of healthi for Huddersfield, lhas had exceptionlal opportunities of appreciating the value] of the various measures suggested, inasmuch as Huddersfield is a townl which hias been a pioneer in these matters. The Infant's Right to Lire. In tile early part of hlis first lecture Dr. Moore laid
more » ... ure Dr. Moore laid down the proposition that a child -was born into the world possessed of certain elemiiental natural rights, quite apar-t and distinct froiim any legal riglt to property it mialgt inlherit. Evervy infant lh-eld these riglhts directly from those from whom it derived its being-that is to say, from its mother and fathier-and indirectly from the community or State into wlich it was .born. The existence Of its direct rights from its inmediate parents did not nullify its indirect riglts from the social organization as a whole. The infant bad a riglht to a reasonable chanee to survive to such an age-period thlat its own action might influence its destiny, and had a right, therefore, to a reasonable degree of protection from external influences which might inmperil or destroy its life. Infant deatlhs from summer diarrlhoea were practically absent from the retuirns in winter, but were numnerous in summer. Infant deaths from bronchitis and pneumonia were practically absent from the returns in summ-ier, but were numerous in winter. Therefore, Dr. Moore araued, in these forms death colmes to infants fromi external conditions, and every infant lhad the inalienable riglit, held botlh from its parents and fronm the State, to be protected from these as well as from otlher external causes of deatlh. He thought it necessary to lay lown tllese propositions in order to oppose tllem to two cloctrines which often found expression. One was, that as many infants were born to lives of m.isery, aInd would never do any good, tlley might be left to die. The other was thlat lheredity counted muclh and environment little; that acquired characters were not transmitted, and that tlherefore most, if not all, of the labour in tlle field was vain. Retrospect. He tllen sketchled the special work done in Huddersfield. First of all, in 190Y2-3, the reports of deaths fromi all causes were scrutinized withi a Tiev of selecting the disease, or group of diseases, likely to repay special preventive measures. Infant mortality was selected for five reasons: (1) The numbers of deaths of infants ccnstituted so large a proportion of the total deaths, tllat any substantial reduction of the infant mortality fiagre would affect a material reduction of thle general deatlh-rate. (2) The causes of deaths of infants in quite a considerable proportion were manifestly preventable. (3) The lives to be saved were at tlhe tlhreshold of existence. (4) When an inifant dies it is through no fault of its own; it appeals from its helplessness and its innocence. (5) The cost promised to be almost negligible. In 1904 a detailed report was presented to tlle sanitary authority, and in 1905 it approved a scheme of work against infant mortality, including the voluntary notification of births to the medical officer of health, and the visitation in their lhomes of all newly born infants immediately after birth by women doctors, followed by voluntary workers. The officials were informed that no inquiry would be nmade as to how many visits they paid. They were not to be in a hurry, but thiey were instructed to spare neither time nor effort in the endeavour to be sure before terminating the visit that the motlier was instructed fully in the kuowledge essential to the welfare of her offspring. Two forms of advice, "short" and "extended," were printed, and were to be left for the information of the mother. In 1906 parliamentary powers were obtained requiring the notification of births to the M.O.H. In the following year Parlianent passed an Act enabling every sanitary authority to require thinotification of lirths, and in 1915 ITIhe lectures were published more at length in the Lancet for April 22nd and April 29th. notification was made compulsory throughlout England and Wales. Dr. Moore tllen gave a summ-nary of conclusions expressed in the reports of the medical officer to the Local Government Board on infant mortality. In commenting upon tlheim, Dr. Moore said that the greatest service they rendered lay in pointing out that sickness and death in infancy meant sickness and death in later life pcrri passu, and continued as follows: The demonstration of the existenee of blots " in good areas and of the existence side by side of areas of high and of low infant mortalities is of great significance. Not cli'mate, nor topography, nior muinicipal sanitation, but lthe lives, the habits of the mothers in the homes, determine the difference. I venture to express the opinion that throughout these conclusions too nmuch im-portance is given to gener.al measures. Because infant mortality is a part only of the general death-rate, and because it is a component thereof wlich presents special characteristics, p-articular action is needed for its elinmination-procedure imamediately directed against those influences and conditions which are pecnliarly inimical to the young. So much in passing; I must recur to this point. A paragraph in the first report does not lead to the samee conclusion as another in the second. They are not irreconcilable. The former tends to show that there is lno evidence that the non-domestic employment of mothers is injurious. The latter is to the efteet that such employment " must necessarily " do harm. I agree with both of these apparently divergent conclusions. I have reason to know for my own district that the former is well founded (I went inlto the question in 1908), and I amn convinced that the latter must be true. But to discuss the matter now would take too long. The influence of the industrial employment of women on family life generally, on Chil1dbearing, and on the health and lives of the infants anld children has not yet received adequate attention. It should be insisted upon that the fam-iily is the unit of tlhe nation. The sum of the families is the nation. This social question of female industrial employment is so great and so complex that no individual can investigate it adequately, even in a lifetime, yet it needs investigation. It may be worth while to express the opinion that the explanation of the apparent irreconcilability of these particular conclusions may be the following: Under satisfactory conditions of family life generally, if in a section of a communlty the mothers worked all day away fromn the homes we would be able to show statistically that such employment caused an excessive infant mortality. But time existing conditions are so bad, the infant nmortality is so excessive, the margin between the inevitable minimum (of something less than 40 deaths per 1,000 births), and the mortality which actually prevails is so great that the effect of the mother's absence from her duties to her offspring is masked by the additional resources commanded by her wages. I cannot' readily accept the dictum that the experience of organizations which supply food to expectant mothers shows that the condlition of the mother before parturition has a definite influence upon the capacity for suckling. On the face of it t}hat conclusion appears to be unavoidable. How can an ill-nourished woman so develop during pregnancy that the mammary tissue shall become adequate? It is not to be expected. Bu-t we have yet to hear advanced the natural corollary that the uterine tissues of the undernourished woman fail to increase and to function (except in such cases as come under the proper designation of asthenia). Moreover, we know that the trophic nerves are able to exercise a selective faculty. And also the oft-cited phenomena of the very low infant mortality observed during the Lancashire cotton fauiine and the siege of Paris increase the difficulty of acceptance of this opinion. True, other factors played a part in Lancashire and in Paris, but it is undoubtedly the case that infants were breast-fed by mothers who had under*oneprivation during pregnancy to an extreme degree, and who, moreover, were semi-starved during suckling. Nevertheless, all women gener ally, and all mothers in particular, hold the natural right at the hands of their fathers, husbands, and sons to be well nourished at all times. I merely deprecate this particular statement about nourishment and suckling lest it should form a reason, or an excuse, to withhold from the infant its natural and only proper fooa. In concluding his first lecture, Dr. Moore dealt briefly with tIme painful and difficult phase of the infant mortality question which related to unwanted iiifants, and incidentally referred to what he, following many otherwriters, MAT 6, i916j
doi:10.1136/bmj.1.2888.659 fatcat:rw5pgwrxtzbn3f6crow6tyvrim